Prospective evaluation of sexual function in patients receiving cryosurgery as a primary radical treatment for localized prostate cancer

Abstract

OBJECTIVE To evaluate prospectively the sexual function of patients undergoing cryosurgery as a primary radical treatment for localized prostate cancer, as the development of 17 G cryotherapy probes has improved the delivery of this treatment, but one of the side‐effects of cryosurgery is the development of erectile dysfunction (ED). PATIENTS AND METHODS Between July 2003 and May 2008, 53 patients were treated using an argon‐based third‐generation cryotherapy system (Oncura, Arlington Heights, IL, USA). Prospective data were collected at 6 weeks, 3 months, then 3‐monthly up to 1 year and subsequently 6‐monthly. Patients were followed up for up to 54 months, with a median (mean) follow‐up 36 (30.5) months. RESULTS All 53 patients were followed after receiving cryosurgery as primary treatment for prostate cancer; 51 (96.3%) had ED at 6 weeks while two (3.7%) were experiencing partial erections. By 9 months one (2.4%) of 42 patients was fully potent using phosphodiesterase type‐5 inhibitors, and six (14.3%) were experiencing partial erections. By 18 months eight (21%) of 39 patients followed up had regained full potency and by 24 months eight (24%) of 33 patients were fully potent and three (9%) experienced partial erections. CONCLUSION While ED is a significant side‐effect of cryotherapy, a considerable proportion of patients who have no ED before treatment (39%) recover full sexual function afterward. Focal nerve‐sparing cryosurgery might be the way forward in an attempt to preserve erectile function in men who had no ED before treatment. Erectile aids should be made available for those patients for whom sexual dysfunction compromises the quality of their life and relationships.

Initial Brazilian experience in the treatment of localized prostate cancer using a new generation cryotechnology: feasibility study

“…Impotence rates vary in the literature. Asterling et al published a prospective evaluation of sexual function in 53 patients who underwent cryosurgery as a primary treatment for prostate cancer with 39% of return of sexual function (28). Additionally, Lambert et al reported up to 71% return of potency in their study (29).…”

Cryosurgery as primary treatment for localized prostate cancer

“…The most common complication was ED. The incidence of ED reported in the literature ranges from 49% to 94% at one year [3][4][5]21]. This complication occurs more frequently after cryotherapy than other local treatments, e.g., nerve-sparing radical prostatectomy.…”

On-demand use of erectile aids in men with preoperative erectile dysfunction treated by whole gland prostate cryoablation

“…The reported probability of maintaining EF were 60% for brachytherapy plus external-beam radiotherapy, 52% for external-beam radiotherapy, 25% for nerve-sparing prostatectomy and 15% for cryotherapy. 11 In terms of EF after cryoablation, there are only a few articles reporting longitudinal changes using either direct interview 12,13 or validated instruments. [14][15][16] Those reports describe that 39.0-51.3% of patients recover EF with penile rehabilitation or using erectile aids.…”